Nurse to Provider Communication Guidelines LTC and SNF

[MarySnov]

Hi,

I need some help, hoping to get resources from you. 

I'm a nurse practitioner.  My provider group has become the medical director of a group of nursing home.  The staff are very nice, but communication is awful.  They don't call us when they should. Or call us for situations that aren't necessary.  They also don't put in progress notes in the charts. 

Examples: 

I found out today that a skilled patient left AMA this morning.  There is no progress note, nothing signed.  I don't know where he went or how or why. 

Last weekend the on call provider got a call at midnight to review labs, none were urgent, Most were WNL.

There was a patient with a BP of 191/111. No phone call. They gave scheduled meds and didn't recheck.

Patient with O2 % at 68%.  They put him on O2 and he came up, but there wasn't a call or a note. 

Those are just a few examples. I end up getting note in my box about the situations later.  Honestly, I feel like I'm trying to teach things that should have already been taught. The previous medical provider was only in the facilities once every 5-6 weeks, and we are going in 3-4 times per week so maybe we are seeing it more. 

We are going to try and put together a guide or book to keep in each facility.  It's so much that it's hard to know where to start. I'm hoping that one of you has a guide or something that you'd be willing to share. That way we can adjust it for our needs.  

Any help would be appreciated. 

 

[JKL33]

 

Quote

It's so much that it's hard to know where to start.

1. Some of these things seem like they're not even following nursing policies that their employer might have. I'd see what they already have, review them and medical director should be addressing with DON.  
 

2. Patients who have specific diagnoses/meds/needs should have associated orders on their chart. Mr X has 2 bp meds (with ordered instructions), should have order for how often bp monitored and parameters to hold, parameters to call. 

Those are two starting places, might help to review these before trying to start from scratch.